DESCRIPTION (APPLICATION ABSTRACT): The overall goal of this application is to improve patient safety in intensive care units (ICU) by identifying and eliminating system failures that lead to errors in care. We will accomplish this goal through the implementation of an ICU Safety Reporting System (ICUSRS) in partnership with the Society for Critical Care Medicine (SCCM) and the Association for Health Care Risk Managers (ASHRM). To support this project, we will draw on a variety of experts in error reporting, including staff from the Australian Incident Monitoring Study, the Food and Drug Administration, and human factors experts. The ICU is an appropriate focus for this application because it is estimated that a significant number of the four million patients admitted to ICUs in the United States annually suffer a potentially life-threatening incident. The specific aims of this project are: 1. To implement in a cohort of ICUs a web-based safety reporting system (ICUSRS) that incorporates a systems approach in the reporting and analysis of incidents; 2. To compare the information provided by reporting near misses versus adverse events with respect to both the quantity and content of error reporting, as well as the opportunities identified to improve safety; 3. To examine providers? perceptions regarding the reporting system, as well as the effects of participation on safety-related attitudes; 4. To explore the usefulness of this ICU error reporting system for safety improvement initiatives at the institutional and professional society levels. We are recruiting sites through the SCCM. Each participating ICU will designate a physician principal investigator who will obtain approval to participate in this project from the appropriate institutional review board (IRB). We will evaluate the usefulness of the ICUSRS for improving safety by surveying providers and by implementing and evaluating individual ICU and collective improvement initiatives. Key to our approach is building a systems analysis into the reporting and analysis process. The SCCM will greatly assist with outreach and dissemination. They are a multidisciplinary society whose members include physicians, nurses, pharmacists, and respiratory therapists; they will greatly assist in encouraging reporting, and in developing a team approach to safety. ASHRM will provide guidance to project participants regarding the risk-management issues involved in error reporting. The approach used for safety reporting in this project can serve as a model for other specialties.